Presentation on theme: "Situation Monitoring “Attention to detail is one of the most important details ...” –Author Unknown ®"— Presentation transcript:
1 Situation Monitoring“Attention to detail is one of the most important details ...”–Author Unknown
2 Objectives Define situation monitoring Define cross-monitoring Discuss the components of the STEP processDefine situation awareness (SA), and identify conditions that undermine SADiscuss the importance of a shared mental modelDiscuss when to share informationRecognize the barriers, tools, strategies, and outcomes of situation monitoring
3 ScenarioMary, a nursing home resident, falls while attempting to ambulate independently. She suffers a head laceration and a possible fractured hip. The nursing assistant, charge nurse, and supervisor all respond to Mary’s call for help.Diane, the supervisor, completes her assessment. She directs Ann, the nursing assistant, to retrieve 4x4 gauze from the treatment cart and Jerri, the charge nurse, to maintain c-spine precautions until EMS arrives. Noticing her confused expression, Diane tells Jerri, “Place one hand on each side of Mary’s head and keep it in straight alignment with her spine.”
5 A Continuous Process Situation Monitoring (Individual Skill) Situation Awareness (Individual Outcome)Shared Mental Model (Team Outcome)
6 Situation Monitoring (Individual Skill) Process of actively scanning behaviors and actions to assess elements of the situation or environmentFosters mutual respect and team accountabilityProvides safety net for team and residentIncludes cross-monitoring… Remember, engage the resident whenever possible.
7 Cross-Monitoring is…Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errorsMechanism to help maintain accurate situation awarenessWay of “watching each other’s back”Ability of team members to monitor each other’s task execution and give feedback during task executionMutual performance monitoring has been shown to be an important team competency.(McIntyre and Salas, 1995)
8 Cross-Monitoring Hi, I’m here to change the dressing on your buttock. That resident has C diff. The treatment nurse should be wearing precaution gear. Should I say something?
10 Status of the Resident Resident History Vital Signs Medications Physical ExamPlan of CarePsychosocial Condition
11 Team Members Fatigue Workload Task Performance Skill Level Stress Level
12 I’M SAFE Checklist I = Illness M = Medication S = Stress A = Alcohol and DrugsF = FatigueE = Eating and EliminationAn individual team member’s responsibility …
13 Environment Facility Information Administrative Information Human ResourcesAcuity of Residents and Team Members’ AssignmentsEquipment
14 Progress Toward Goal Status of team’s resident(s)? Goal of team? Tasks/actions that are completed or that need to be done?Plan still appropriate?
15 Situation MonitoringRecollect examples of situation monitoring, in which you needed to—Be aware of what was going onPrioritize and focus on different elements of the situationShare this information with othersSelect one or two that best represent the concept of situation monitoringShare
16 Situation Awareness is… The state of knowing the current conditions affecting the team’s workKnowing the status of a particular eventKnowing the status of the team’s residentsUnderstanding the operational issues affecting the teamMaintaining mindfulness
17 Conditions That Undermine Situation Awareness (SA) Failure to—Share information with the teamRequest information from othersDirect information to specific team membersInclude resident or family in communicationUse resources fully (e.g., status board, automation)Document
18 A Shared Mental Model is… The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication.“Teams that perform well hold shared mental models.”(Rouse, Cannon-Bowers, and Salas, 1992)
20 Practical Exercise Gloria Valdez New admission 87 years old Dementia diagnosisConfused, anxious since admissionInvolved daughter
21 How Shared Mental Models Help Teams Help ensure that teams know what to expect, so if necessary, can regroup to get on the “same page”Foster communication to ensure care is synchronizedEnsure that everyone on the team has a picture of what it should look likeEnable team members to predict and anticipate betterCreate commonality of effort and purpose“ Shared mental models help teams avoid errors that place patients at risk.”
23 When To Share? Briefs Huddles Debriefs Transitions in Care ... Share information as soon as possible when a change occurs in the resident’s status.
24 Situation Monitoring BARRIERS TOOLS and STRATEGIES OUTCOMES Hierarchical CultureLack of Resources or InformationIneffective CommunicationConflictTimeDistractionsWorkloadFatigueMisinterpretation of DataFailure To Share InformationTOOLS and STRATEGIESBriefHuddleDebriefOUTCOMESSituation AwarenessShared Mental ModelAdaptabilityTeam OrientationMutual TrustSTEPCross-Monitoring
25 Teamwork ActionsConduct team exercises to increase situation monitoring skillsShare information in a timely fashionInclude resident and/or family in communicationUse cross-monitoringApply the STEP process when monitoring the situationFoster communication to ensure that all members of the team have a shared mental modelShare information during briefs, team huddles, debriefs, and transitions in care“Teams do not seek consensus; they seek the best answer.”–Katzenbach and Smith